Your Questions

Q: Dr. Eppley, Regarding lip advancements, after giving it much thought, I agree that a sub nasal lip lift would not achieve the results I’m hoping for and would love to move forward with the upper/lower lip advancements paired with upper/lower V-Y for projection. That said, while I know you’re a master of scars and so the risk is relatively low, I would love your thoughts on how I can correct less-than-ideal scarring should it happen. I’ve heard methods like CO2 lasering or even lip tattooing can help, but I would love your thoughts on the best options in case, just in case.

A:When it comes to treating lip scarring, I’m Almost always surgical revision is the best route. This of course depends on what the magnitude of that scarring is. But most of the time this is a fine white line let maybe 1 to 2 mm wider than we ideally want. People spend a lot of time and resources on laser resurfacing but this is really not usually a good route to go. Depending upon the fine line scarring it is always possible that lip tattooing is a good backup plan but the first and primary goal is to have a scar that looks good enough that does not mean anything done.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, So this is what my profile looks like right now, primarily trying to get height in the lower third, and just wanted to know what my options are. I do think a bimax with maxillary downgraft would probably be my best option but I’m trying to avoid a very invasive procedure like that. Was more thinking of genio with chin implant for some verticality but not sure how good that would look.

Is there any implant+genio approach that would be able to get me sufficient height in the lower third or would orthognathic be my only option for that?

A:If the goal is vertical facial lengthening you’re not going to find a Bmax procedure with downgrafting  very favorable as this Is going to on lengthen your midface with potentially excess tooth show. So beyond that being a very invasive procedure it probably is not going to be that aesthetically beneficial and may have adverse tradeoffs

Jaw osteotomies aside you then have to decide whether it is vertical chin lengthening alone or total jawline lengthening that you desire. Vertical chin lengthening can be done by a bony genioplasty or an implant depending upon how much vertical length you actually need. If the goal is total jawline lengthening then a custom implant would be required to do so which may or or may not be combined with a bony genioplasty depending upon how much vertical chin length is needed.

To help illustrate these basic vertical lengthening concept I have attach some initial imaging showing the differences between chin only in total jawline vertical lengthening.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,, I’m seeking your expert opinion on revising a complex aesthetic and soft tissue issue following multiple surgeries of the chin/jaw. Background: I have condylar hyperplasia — my right jaw joint grew longer than the left, causing my entire jaw and chin to be skewed to the left. The right side of my face is noticeably bigger than the left. To try to improve this asymmetry, I had my first genioplasty in my early 20s, However, by my early 30s my chin still sat too far to the left, so I had a revision genioplasty. Even after the revision, my jaw remained crooked, so I had orthodontic treatment (braces) in preparation for full double jaw surgery to properly realign everything. I underwent double jaw surgery at the end of 2022, and the surgeons reversed the previous genioplasty at that time. Unfortunately, I developed two infections after surgery, which required them to remove the lower plates — so my lower jaw has been cut into and operated on multiple times. Current concern: Since all these surgeries, I now have persistent lower lip incompetence: My bottom lip does not touch my top lip at rest. My bottom teeth are always visible, and the lower lip sits too low and slightly everted. This looks unnatural and really affects my confidence. I believe this is due to mentalis muscle detachment, soft tissue stretching, and scarring from multiple surgeries and infections. What I’m hoping for: Your expert assessment on what is causing this — mentalis detachment, scar contracture, tissue deficiency, or all three. Your advice on whether mentalis resuspension (possibly with vestibuloplasty and dermal-fat grafting) would be suitable and realistic for me, given my extensive surgical history. Examples of similar cases you have corrected (before/after photos, if possible).. I can provide detailed photos (frontal, profile, lips at rest and forced closed), plus all my surgical and orthodontic records if helpful. I’m open to a virtual consult and prepared to travel from Australia if you think I am a candidate. Thank you so much for your time and for considering my situation, I truly appreciate your expertise.

A: Thank you very your inquiry and detailing your a complex surgical history… although when it comes to lower lip incompetence this is not an unusual background. The problem is your prior genioplasty has been reversed, losing support to your soft tissue chin pad and lower lip. Well I do not know the dimensions of your prior genioplasty any loss of horizontal projection and having head multiple surgeries to do so is going to result inching pad contraction and lower lip incompetence.

That being said there are limited surgical options to try to improve it which, from my experience, means basically do everything that you know how to do and hope it provides adequate improvement. Thus, as you have mentioned, mentalis resuspension, dermal fat grafting and a shortening vestibuloplasty are all of the soft tissue procedures. How this applies to you I cannot say based upon a verbal description alone.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, is it risky or dangerous to do forehead reduction and hairline advancement at once? And you can’t do the forehead flatter than you showed me in the imaging?

A: It is common to do both forehead bone reduction and hairline advancement at the same time.

In imaging I try to show what I think is a certain amount of foreherad bone reduction …as that should be the trigger for surgery. Whether more may occur can not be known beforehand.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q:Dr. Eppley, I am considering having cosmetic surgery to improve my chin/jaw. I feel like my small chin gives my face a boyish/weak look. I would like my chin to be considerably stronger and more prominent to balance my face. Could I be a candidate for a sliding genioplasty? I would prefer to avoid implants.

A: With the focus on the small chin and with an emphasis on avoiding implants then by these parameters a sliding genioplasty would be the treatment option. This is a good treatment option provided one does want want the chin any wider or have a specific shape (square chin).

Now it is a question of determining what are the desired dimensions of the chin bone movement that look best to you. To make that determination a would need a side view picture of your face to do some predictive imaging.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, my son is almost 3 years old and has plagiocephaly that is noticeable. I am wanting information regarding the surgery to correct his skull. Thank you.

A: In aesthetic skull reshaping surgery I don’t treat patients under the age of 18 years old.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I found your practice by researching the arterial pulse in my cheek just left of my mouth. It showed up a few years ago and is now very noticeable, extremely so in certain lighting. I’m hoping to consult about surgical options. Scar potential and price. I’m attaching a photo of the location.

A: Your picture shows a classic facial artery pulsation in its location and appearance. This occurs at the bifurcation of the facial artery at the level of the corner of the mouth where it splits into a Y with one branch heading to the upper lip and the other along the side of the nose. Its cause is either an aneursym of the bifurcation or an aberrant loop of one of the takeoffs of thr branches. Treatment is by ligation of the pulsatile branch by an overlying small direct incision.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in a custom jawline implant and photos were requested for imaging.

  I would like to send new photos to use for the editing process but I do have some filler in my chin, probably 1/2 syringe or slightly more. Is it best for me to dissolve the filler before sending photos so it’s represents the most accurate depiction of my chin?

A: FYI Imaging is not about showing patients their results. Rather it is about determining the patient’s goals. 

That being said whether the filler should be dissolved depends on the magnitude of its augmentation effect. If it is modest in effect then I would leave it. If its effects are more significant than I would dissolve it.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, How can my wide forehead and skull be reduced?

A:Thank you for sending your pictures. In assessing them it is important to recognize that the enlarged temporal muscles contribute as much if not more and that of the wider skull forehead bone. Thus treating both bone and muscle is extremely important for a satisfactory reduction. In fact that concept is so important that if you reduce the skull bone without reducing the muscle it would look even worse.

While it remains to be seen how much bone reduction your skull thickness will permit the enlarged temporal muscle has no such limits and will provide a greater reduction then that of the bone. Attached is some imaging of what I think in the best case scenario can be achieved.

Dr. Barry Eppley

World-Renowned Plastic Surgery

Q: Dr. Eppley, I had FFS four years ago and I am on the path of detransition and want to see what could possibly be done to give me back more masculine face especially my forehead, brows chin and nose.

A:While I don’t know what exact procedures you had in your FFS surgery three years ago I would assume that most of them were structural in nature. You have mentioned three structural areas in your inquiry being that of the fore head, nose and chin. Thus it would be logical to assume that forehead-brow bone, nose and chin augmentations would be helpful. To make a more accurate assessment these potential changes it would be helpful to see a side view picture of your face as well as well as pictures of what you look like before your FFS surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Inquiry Regarding Facial Harmony and Jaw Surgery Options. I’m reaching out to consult you regarding a long-standing concern I have with my facial structure. I feel that my face appears too oblong, with limited forward projection and a pronounced gonial angle. These aspects have impacted my confidence, and I’m exploring possible surgical options to improve my facial harmony and jaw definition. Specifically, I would like your expert opinion on whether a double jaw surgery (maxillary and mandibular advancement) would be appropriate in my case to enhance midface projection and balance. Alternatively, could jaw implants — particularly to improve gonial angle definition — offer an effective solution on their own? Additionally, I’ve noticed some jaw asymmetry, which I’m hoping to address. I am currently undergoing orthodontic treatment to correct a slight overbite and align my teeth. Could you please let me know what diagnostic steps (e.g., imaging, consultation) you would recommend to evaluate my candidacy for either approach? I would greatly appreciate your guidance on the best path forward. Thank you in advance for your time and expertise.

A: Thank you for sending all of your pictures. Based on these pictures it is hard to imagine the double jaw surgery has any benefit for you. Your midface lack of projection concerns lie above the LeFort I osteotomy level in which only in for orbital – malar implants can be of benefit. Asymmetry aside your lower jaw simply lacks some more defined structural enhancements at the chin and jaw angle areas. Again this is best treated by an implant approach rather than jaw bone surgery. (aka SSRO advancement) Jaw asymmetry is almost always best treated by a 3D implant approach as well.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, I have a protuberance on my occipital bone that bothers me aesthetically. I would like to reduce it to improve my appearance. Is it possible to reduce it? This is my CT scan.

A:Thank you for your inquiry and sending your picture and x-rays. You have an acceptable bone enlargement which I have seen many times before. Your 2-D and 3-D CT scan show that the bone has more than adequate thickness to get a significant surgical reduction.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have a flat back side of my head. I was just wondering how long the process is? how long i would have to be in recovery? Will I be under? Or awake for this procedure?

A:Thank you for your inquiry and sending your pictures. You have a classic flat upper back of the head which is treated by a custom skull implant. Such a skull implant is made from the patient’s 3-D CT scan which they initially get where they live through our orders. The implant design and fabrication process takes 2 to 3 months to have it ready for surgery. Surgical placement of a custom skull implant is done under general anesthesia and, depending upon how are you choose to define recovery, gets some postoperative swelling which will take 10 to 14 days to largely go away.  There is no otherwise recovery limitations other than that of the swelling.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in mentalis muscle/chin pad resuspension. I’m highly motivated, but the operation must improve my aesthetic and medical condition, not make it worse of course.Since the primary genioplasty, I’ve had enormous discomfort in speaking, with this feeling that the muscle is preventing me from going back up, which borders on the internal scar of the vestibule. The mentalis muscle is very active and doesn’t seem to communicate with the lower lip despite all its efforts 🙂 the vestibule in my case is very deep with a large internal scar that seems to create a border and separate the muscle from the lower lip area, which is far too low. On the frontal X-ray, you’ll see that there’s some kind of wire (and maybe plates and screws or not ?) preventing my muscle from rising?

IN PROFILE YOU can see the chin (added or not) and the material that can support the higher attachment of the muscle?

I understand that there is a combination of techniques: muscle suspension, chin support (yes?) and a shortening vestibuloplasty? (shortening the depth of the vestibule by sewing the two edges of the vestibule mucosa higher together to support a higher lower lip and prevent relapse).

If the doctor sees a lasting solution I am available.

A:Thank you for sending your x-ray which shows a single wire ligature, which an old-fashioned method for chin osteotomy fixation, can be effective based on the amount of chin bone movement. That being said the wire ligature it is not impeding muscle movement although it would be removed in mentalis/chin pad resuspension surgery. As you have correctly noted mentalis resuspension is more then just a single technique and involves multiple combined tissue approaches as you have mentioned.

While there are no other methods to improve your problem, as I have previously pointed out, mentalis and chin pad resuspension is a challenging procedure with variable long term outcomes. There are no guarantees in any surgery and mentalis resuspension is no different. The question is not whether it will make anything worse, which it will not, but how much improvement in the long-term can it achieve.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have a question about skull reshaping material PMMA.On your website it reads the material has flexibility and it qualifies as silicon on the periodic table.My question is: once the PMMA piece has been inserted under the scalp, if you press upon the scalp, does it feel soft or does the scalp feels hard like skull?

A:The use of PMMA (bone cement) has long been abandoned in aesthetic skull augmentation due to inferior results compared to custom silicone skull implants which also feel just like bone. PMMA is a synthetic plastic polymer while silicone is more pure element.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I noticed that Dr. Eppley specializes in clavicle lengthening osteotomy. This is something I would also be interested in. I had a right clavicle fracture which was missed and resulted in a malunion. My right shoulder and arm are sagging, and my neck seems to be narrower at the base. My goal is to have the malunion fixed and symmetry restored.

A:You are referring to a right clavicle lengthening procedure to try to improve shoulder symmetry. The key element in considering that procedure is what does the shape of the right clavicle bone look like. X-rays are needed to measure the differences in the links of the two sides as well as that of the angulation of the classical bone. Ideally the 3-D CT scan it’s best to appreciate three dimensional differences and the length in shape of the clavicle. However even regular clavicle x-rays would be useful.

You use the term of ‘fixing the malunion’ but I suspect it is no longer a non healed bone. Rather you likely have a healed right clavicle that is both shorter and now with the different angulation then that of the left side. That distinction is important as a true nonunion requires an autologous bone graft. Conversely a healed fracture site may not need a bone graft for straightening. But this is where radiographic analysis of The two clavicle bones is paramount.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am curious about what you offer when it comes to rib remodeling. I am a transgender person looking to not just narrow my ribs at the waist but further up to my 7th rib if possible .i am also wondering if the precedure that he preforms to do this will also reduce the projection of my ribs at the front. Aka rib flair. Many thanks.

A:I have done rib removal/remodeling up to rib number eight but not rib number 7. Ribs 10 through 12 are treated I sub total removal. Conversely due to their different anatomy ribs nine and eight are treated by and ostectomy with plate fixation to reduce their arc. I don’t see any benefit to treating ribr number 7 is that is almost at the breast level.

The anterior subcostal ribs when treated for excessive flare are usually treated by two point cartilage weakening with postoperative garment compression/remodeling.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in a head oval shaping operation. I would like to ask about the whole process. starting from the consultation ending with the operation. How does this process work? is an online consultation enough and after that I can make an appointment for the operation right away?

A:The first place to start is to get some pictures of your head and a description of your shape concerns and objectives. Based on this information I can determine if what you want to accomplish it Is possible. Then we can move onto a more in depth discussion via virtual consultation.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr  Eppley, I am a 20 year old woman with a naturally slim build, but despite being pretty skinny, my clavicles are not visible or pronounced in the way I would like them to be. This has been a long-standing aesthetic concern for me, and I’m reaching out to ask about your custom clavicle implant procedure. I am particularly interested in whether such an implant could be made very prominent, as I am hoping for a more visibly defined clavicle contour — even at rest, without tensing or lifting my shoulders. I also have a few medical and lifestyle concerns I hope you can advise me on: 1. Is this type of implant safe and effective for aesthetic-only purposes (without previous trauma or asymmetry)? 2. Would I be able to return to sports and physically intense activities, such as weight training or even skydiving, once fully healed? 3. Where is the incision made, and how large is it typically? I unfortunately tend to develop keloid scars, so this is something I’d like to plan around carefully.

A:Thank you for your inquiry regarding clavicle enhancement surgery. In answer to your specific questions about it:

1) This is a very safe surgery that I have learned based on my extensive experience with clavicle reduction and clavicle lengthening surgeries. The clavicle can be circumferentially elevated from its external attachments immediately to its shoulder attachments laterally and then a predesigned implant can be wrapped around it much like a tube. Like all aesthetic implants the question is always how much size is needed to create the effect. In this case it is a matter of how thick the enveloping layer of the tube implant should be. As a general rule a 5 mm thickness Will increase the clavicle diameter by 1 cm which should be effective in a thin person for improving clavicle show.

2) Placement of such a wraparound clavicle implant will in no way impede any subsequent sports or physical activities.

3) The incision used to place the clavicle implant is the same as that is done for clavicle reduction surgery, a 3.5 cm incision behind the clavicle in the supraclavicular fossa. Such incisions heal extremely well with minimal visibility in my extensive experience with them. This is not an area due to the very thin skin that is prone to develop any hypertrophic scarring. Having performed hundreds of such incisions I have yet to see a bad scar result.

Dr. Barry Eppley

World-Renowned Plastic Surgery

Q: Dr. Eppley, I am interested in learning more about cosmetic skull reshaping procedures. I’ve been researching options for correcting certain head shape irregularities and would greatly appreciate your expert guidance.

Specifically, I am looking to address:

      •     A sloped forehead that I would like to make fuller or more vertically aligned.

      •     A flat back of the head that I would like to augment for a more rounded appearance.

I have a few key questions regarding the procedures:

      1.    Safety: How safe are these types of skull reshaping surgeries? Are there major complications to be aware of?

      2.    Risk Minimization: What steps do you take to minimize surgical risks or complications (e.g., infection, implant shifting)?

      3.    Materials Used: What materials are typically used for forehead and occipital augmentation, and are they permanent?

      4.    Cost: Could you provide a general cost estimate for both forehead reshaping and back-of-head augmentation?

      5.    Scarring and Healing: Where are incisions made for these procedures, and how visible are the scars over time?

      6.    Suitability: Are there any specific factors (head shape, scalp flexibility, skin condition, etc.) that would impact candidacy for this procedure?

I’m very serious about pursuing this and want to ensure I’m well-informed before taking the next step. Thank you for your time, and I look forward to your response

A:Thank you for your inquiry and sending your pictures. Based on these pictures I can see the flat upper back of your head but I can make no comment on your four head since it is not included in the pictures. In answer to your specific questions:

1) Skull shaping surgery is as safe as any other aesthetic surgery.

2) While all surgery has inherent risk I have never yet seen a skull implant infection or have an implant move or shift. This does not mean these postoperative events could not happen just thought the risk profile is obviously very low.

3) All custom skull implants are made of a solid silicon implant material to structurally permanent and can undergo no amount of degradation.

4) Cost estimates will be provided to you for a custom back of the head and custom for head implant.

5) The incisions used to place custom skull implants are very small compared to the diameter of the implants. An incision is placed at the bottom of the hair line for the back of the head and another small one behind the frontal hairline for the four head implant. While all incisions create permanent scars these have never been viewed as a significant postoperative aesthetic issue.

6) Given the areas of skull augmentation that you are considering there are no limiting factors that would not lead to a satisfactory augmentation result.

Dr. Barry Eppley

World-Renowned Plastic Surgery

Q: Dr. Eppley, I have attached a photo, and I drew blue lines. I am concerned that my skull bulges out laterally, whereas the angle in most females goes toward the center as the blue lines indicate.  It is less apparent in photos and more noticeable in person.  But hopefully this helps.  Please let us know if there are other angles you would like to see.

A:Thank you for sending your pictures and marked illustrations. You have the classic wide forehead and large anterior temporal muscles. It is important to recognize that the enlargement of the temporal muscles makes as much contribution to this appearance is that of the bony for head with. This is treated by narrowing the fore head by reduction of the bony temporal lines and subtotal reduction of the anterior temporal muscles. To do so this requires hey scalp incision placed either at the frontal hairline or behind it in a more coronal fashion. One can debate whether you should also vertically shorten the long fore head which, on one hand seems appropriate given its length, but on the other hand shortening the forehead works against making it look more narrow.

Dr. Barry Eppley

World-Renowned Plastic Surgery

Q: Dr. Eppley, am I a good candidate for hip implants?

A:To determine if you are a good candidate for hip implants I need to have the following information:

1) current pictures of your hips

2) pictures that show your desired hip augmentation goals

3) prior surgical history that may include fat grafting and/or synthetic filler injections to the hips

This information is relevant because the most successful hip implant augmentation patients who have the lowest risk of complications have modest hip augmentation goals (not too large of an implant) and have no prior history synthetic filler injections into the hips in particular which is an absolute exclusion for the procedure.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in glagella furrow reconstruction. I recently had a brow lift and filler but still no improvement.

A:The surgical treatment of a deep glabella furrow that is refractory to Botox, injectable fillers, an endoscopic release is a direct excision of the furrow with a placement of a glabellar implant beneath it. Between the muscle removal and the placement of an implant beneath it the furrow is significantly reduced or completely leveled. This does, however, create a small fine line vertical scar in its place which is the length of the original furrow. Thus usually this procedure is reserved for older patients with extremely deep V shaped single midline furrows. You are a bit younger than most patients who would have this procedure and your likely goal of a smooth glabellar area that is wrinkle free may not be achievable.

Dr. Barry Eppley

World-Renowned Plastic Surgery

Q: Dr. Eppley, My head is not evenly shaped and I want to explore options for contouring.

A:Thank you for sending your pictures as this is the first I’ve seen them. What day demonstrate to me or two issues. First there is hey left sided top of the head asymmetry where the parasagittal area is lower and the bony temporal line is more per truce then the other side this is undoubtably the most major issue due to the asymmetry scene. Secondly, on the back of your head there is an exit little knob with a small scalp roll which may or may not be of any concern to you.

In looking at the primary school shape issue hey successful outcome would be based on augmenting the left depressed parasagittal area as well as reducing widen bony temporal line. The first is very straightforward to do with the custom skull implant which is done through a very small scout implant which would leave virtually no significant scar.. The widened temporal bony line, however, is more challenging from an incisional standpoint as to adequately reduce the widened bone this needs to be burred down along its length from the forehead all the way to the back of the head. While this can be done my aesthetic concern would be the necessary incisional length to do so.

Considering both procedures the attached image is what I think your  skull reshaping goal would be.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I always desired a pointy chin. I did two surgeries already to add a silicone implant, but as usual, there are no available silicone implants which are pointy

In this picture I am with the new implant which doctor has placed on my chin (purple hair) But I would like my chin to be more pointy.. or projected in the frontal area only, not on the sides

Actually I have spoken with my doctor and he said that maybe in my situation I should go for a bone reshape surgery, because in my situation, not only the implants are not giving the proper result, but also the bone has a masculine shape. And I would like to have a more feminine chin

Those above are my pictures before the implant surgery. So you can see that my chin was always a bit more masculine because of my chin bone. So what does doctor suggest? I would like to know an honest opinion if in my situation better to do bone reshaping or if a pointy implant would work.

A:Creating a pointy chin in a female can be done at one of two ways. If one is not opposed to implant you simply take the standard implant and modify it to be pointy or make a custom implant design. If one as opposed to an implant then you can do a T-shaped bony genioplasty to create that effect. Because an implant can create the most V-shaped change to the chin this will likely have a better effect on creating a pointy shape than even a T-shaped bony genioplasty. Just because there is no standard implant that has that effect there are many ways around the implant design issue as I have already mentioned and you have already attached a picture which shows how to address such a chin implant design.

Since you already have a chin implant and clearly are not opposed two an implant I would think the simpler and most effective solution would be to do it to a proper implant design.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, I’m interested in Injectable cranioplasty. I was diagnosed with Gorham disease, causing two dents/indentations on my forehead.

A:Injectable cranioplasty as a skull contouring technique was abandoned years ago due to the high incidence of irregularities and edge contour issues which then required an open approach to solve. It was  replaced by custom skull implant designs which offer more reliable contouring results and equally small placement incisions. How any of this applies to you requires a picture assessment of your forehead indentation contour issues.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, yes in my case it wouldn’t even be forward growth, it would only be horizontal. I have a crossbite and mild sleep apnea, so it would just be for tooth crowding. I’m not sure I want to go through with it, but I was wondering if I did, if it would affect the implants placed on my midface. I still want to go through will all the procedures we have discussed, I just want to know if in the hypothetical case I did marpe, whether I should, proceed with the planned procedure, divide the current procedures into two surgeries, or wait to do them.

A:I don’t believe that MARPE therapy would have any impact on mid face implant argumentation whether it was done before, during, or after implant placements.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had a genioplasty almost 6 months ago and then I had to get a revision in April or 2 months ago exactly because the bone was not healing. When I touch my chin it feels fleshy, so some of the volume is soft tissue since it was reduced from the first genioplasty. When I see people who have chin implants I feel so envious since I feel like the implants give such a contoured and tapered look. Here is my question. Based on what you see do you think I could get a very very small implant just to give it a shape that is more contoured and tapered? Is there an implant small enough for this?

A:As a general statement one can always add a shaped implant to the end of the chin bone even though one has had prior genioplasty. The key question is the more implant projection the implant creates the more a tapered shape is going to be seen. However that may or may not be more projection then you can aesthetically tolerant. A ‘very very small chin implant’ which can have a very V-shaped tapered shape may not necessarily create much of a difference externally if you have a thick soft tissue chin pad.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, For my potential side of my waistline reduction the line I have drawn on the first picture indicates how my skin sits when I’m not wearing any clothes (or pulling on it) this part of skin hangs over when i’m wearing basically anything that sits fitted on my waist, for example leggings, gym shorts, jeans, bodycon skirts etc.

The other photo is the approximate markings of where the loose skin starts and finishes when being pinched and ideally would not like any more taken off in height.

I am also assuming that upon the rib removal and partial muscle removal there will be additional space there to remove more skin, due to the rib no longer sitting in that space any more? please let me know if this is correct or not. Thank you

A:Thank you for sending your illustrated pictures. I have marked on them the pattern of excision taste upon your markings as well as the length of the resultant scar line that would result from doing so. Given it’s comparatively shorter lengths come compared to vertical back lift I can certainly see why this is a consideration. This also provides excellent exposure for maximum rib and muscle removal. You’re also correct even though this is an excisional area in which the closure is always under sound tension the removal of the underlying tissues helps alleviate some of the tension on the closure which is favorable for a long term scar appearance. However, like all body lift procedures you hope for the best scar result but you mentally plan that you may need a secondary scar revision for optimal appearance.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I would love some information on the crescent knee lift. I have attached pictures of my knees.

A:Thank you for sending all of your neat pictures. Unfortunately, I question how good of the candidate for a kneelift procedure you are. The knee lift is a classic example of understanding the concept of being careful about trading off one aesthetic problem for another. The obvious trade-o the knee lift is that of the scar. One has to be certain that they don’t choose an aesthetic problem that they may dislike just as much if not more than the original problem. Because of this scar concern most successful knee length patients have a lot redundant suprapatellar skin folds. While you certainly have some of that it is not excessive like many of the knee lifts that I have done. How well the scar would do in your case and whether you would consider that better than what you have now is the unknown question. Given its location and visibility one has to give careful thought to this consideration

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Dr. Barry Eppley

World-Renowned Plastic Surgeon